This randomized, multicenter clinical trial evaluated the effectiveness of 2 treatments for deep caries lesions - partial caries removal (PCR) and stepwise excavation (SW) - with respect to the primary outcome of pulp vitality for a 3-year follow-up period. Inclusion criteria were as follows: patients with permanent molars presenting deep caries lesions (lesion affecting ≥ 1/2 of the dentin on radiographic examination), positive response to a cold test, absence of spontaneous pain, negative sensitivity to percussion, and absence of periapical lesions (radiographic examination). Teeth randomly assigned to PCR (test) received incomplete caries removal and filling in a single session. Outcome success was evaluated by assessment of pulp vitality, determined by pulp sensitivity to a cold test and the absence of periapical lesions. Data were analyzed by a Weibull regression model with shared frailty term (survival analysis). At baseline, 299 treatments were executed: PCR, 152 and SW, 147. By the end of the 3-year follow-up period, 213 teeth had been evaluated. Adjusted survival rates were 91% for PCR and 69% for SW (p = 0.004). These results suggest that there is no need to re-open a cavity and perform a second excavation for pulp vitality to be preserved (Clinical trials registration NCT00887952).

Aim: The aim of this study was to evaluate the effectiveness of partial removal of carious dentine and restoration in a single session (PDR) and stepwise excavation (SW), both of which are treatments for deep carious lesions, in Public Health Services in Brazil. Methods: Inclusion criteria: patients ≥6 years old, permanent molars with deep caries lesions (having a radiolucency halfway or more into dentine) and pulp vitality but absence of spontaneous pain, positive percussion test, and periapical alterations. The subjects received either PDR (test group) or SW (control group). The radiological and clinical exams were performed after a mean time of 18 months. Outcomes: success was defined as pulp sensitivity to cold test and absence of periapical alterations. Results: Of the 299 treatments performed, 146 were SW and 153 were PDR; 122 were amalgam restorations and 168 resin-composite restorations. There were no differences between the groups regarding the baseline characteristics (i.e. age, gender and family income). After 18 months, 212 evaluations were performed, which indicated 99 and 86% success rates in the PDR and SW groups, respectively (p = 0.016). Reasons for failure were: PDR – 1 pulpitis; SW – 8 pulpitis; 1 osteitis; 4 necrosis; 1 endodontic treatment. None of the baseline variables were significantly associated with the outcomes. Conclusion: The retention of carious dentine does not interfere in pulp vitality. Data from this 18-month study suggest that the procedure of reopening the cavity to remove the residual infected dentine is not necessary.

This study supports the PCR as a single-visit technique to manage deep caries lesions in permanent teeth.

This study assessed the extent to which clinically measured oral health conditions, adjusted for sociodemographic and oral health behavior determinants, impact adversely on the oral health-related quality of life (OHRQoL) in a sample of Belgian young adults. The null hypothesis was that, among young adults, the oral health conditions would have no impact on their quality of life. The participants were 611 new patients aged 16-32 years seeking consultation at the Saint-Luc University Hospital in Brussels in 2010-2011. The patients (56.0% female) were examined for their oral health conditions and answered a validated questionnaire about sociodemographic and oral health behavior determinants in addition to questions about their OHRQoL. The abridged Oral Health Impact Profile-14 was used to assess the OHRQoL. Interexaminer reliability for caries was 0.86 (95% CI 0.84-0.89, nonweighted κ). The outcome was a high score on the OHRQoL (median split). Hierarchical logistic regression analysis showed that young adults with clinical absolute D₁MFS scores between 9 and 16 (OR = 2.14, p = 0.031) and between 17 and 24 (OR = 3.10, p = 0.003) were significantly more likely to report a high impact on their quality of life than those with lower scores. Also, periodontal conditions compromised significantly (OR = 1.79, p = 0.011) the quality of life of young adults. In conclusion, this study identified oral health conditions with a significant adverse effect on the OHRQoL of young adults. However, the prevalence of young adults reporting impacts on at least 1 performance affected fairly often or very often was limited to 18.7% of the sample.

Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

Quantitative defects of the enamel are considered risk factors for caries development at the cavitated level. Since caries risk assessment and control should be implemented as early as possible in order to prevent operative treatment, it seemed interesting to investigate the relationship between enamel defects and caries development in the stages of progression that precede cavitation. The impact of enamel defects and selected child-mother indicators on early caries development was investigated in a cohort of Brazilian preschool children. The null hypothesis that developmental defects of the enamel and dental caries are independent and that an association between them occurs by chance was tested. The sample (n = 1,718) was made up of 2- to 5-year-olds. Developmental defects of enamel and caries on buccal surfaces were identified in 48 and 26% of the children, respectively. Bivariate analyses at the surface level showed neither an association between demarcated/diffuse opacity and caries experience (p ≧ 0.64, GLM), nor between the presence of hypoplastic surfaces and non-cavitated lesions (p = 0.29, GLM). The multivariate analyses indicated that in the mouths of individual children, hypoplastic surfaces were more likely to present filled surfaces and non-cavitated/cavitated lesions than non-hypoplastic surfaces (within-child p = 0.03, GEE). However, children having teeth with hypoplastic surfaces were not at higher caries risk than those children who did not present hypoplastic surfaces (between-child p = 0.23, GEE). The null hypothesis could not be accepted for quantitative defects such as hypoplasia, since they had a significant impact on the within-child prevalence of filled surfaces and non-cavitated/cavitated lesions.

The aims were to analyse caries trends in Brazilian non- privileged preschool children from 1996 to 2006 and to test the hypothesis that a decline in caries prevalence would manifest itself as a reduction in the rate of caries progression. Subjects were 1- to 5-year-old children born in and life time residents of the Federal District of Brazil (cohort 1996 = 1,465) and (cohort 2006 = 2,511). The clinical examination determined whether the tooth surfaces were sound, presented active lesions (non cavitated and cavitated), inactive lesions (non-cavitated and cavitated), fillings, were indicated for extraction or had been extracted. Intra- and inter-examiner reliability of caries scores showed κ values ranging from 0.71–0.93. A significant increase in the percentage of children who were free from any form of untreated or treated caries was observed (p < 0.05; χ² test). Caries prevalence decreased by almost a half from 1996 to 2006. Differences in the mean caries scores at surface level, which included non-cavitated lesions, were observed for all age groups (p < 0.002; Mann-Whitney test) indicating a reduction in the rate of caries progression. In conclusion, since this population has access to fluoride and presents moderate caries prevalence, other measures to reduce the rate of caries progression are required to further improve oral health in non-privileged children.

The study aimed at identifying oral health determinants that are present in early childhood, are amenable to change and for which there is evidence of their modulation of the rate of caries progression in a sample of non-privileged children. The null hypothesis was that determinants associated with the child's institutional environment as evidenced by nursery policies significantly influenced the child's oral health. The sample was formed by 2,511 Brazilian 1-5-year-olds. Caries severity and activity were recorded. Parents were interviewed and nurseries answered a questionnaire. According to the case status d₁efs, the final multilevel model (generalized linear mixed model) identified significant associations with determinants such as bottle-feeding the child during the night on demand, not assisting the child in toothbrushing, ensuring visit to the dentist in case of troubles with teeth only (p < 0.0001) and intake of sugary products 2-4 times daily at nursery (p = 0.026). The likelihood of caries outcomes was associated with determinants related to nursery policies, not promoting preventive oral health care for children of mothers with 4 years of education (OR = 2.14; p < 0.0015) and <4 years of education (OR = 2.6; p = 0.0010), as well as consumption of sugary products 2-4 times daily for children of mothers with 4 years of education (OR = 3.35; p = 0.0010) and <4 years of education (OR = 4.07; p = 0.0063). In conclusion, determinants related to parental negative practices and to nursery policies significantly influenced children's oral health. Of particular interest was the identification of determinants considered amenable to change in connection with nursery policies towards oral health.